Proximal risk factors for chronic disease in Ontario, Canada: Challenges and opportunities of a comparative perspective

There is emerging literature on lessons from one risk factor to another: tobacco control experiences for reducing unhealthy diet, obesity, physical inactivity or high-risk drinking (Arora 2005/2006; Garcia 2008; Green et al. 2006; Musingarimi 2008; Warner 2005; Yach et al. 2005) or several risk factors (Ashe et al. 2003; Kersh & Moore 2002).

Goal: To summarize challenges and opportunities of translating lessons from Ontario's tobacco control to promoting healthy eating, weight management, active living and reducing high-risk alcohol consumption.

Methods: Analysis of published literature, government documents, NGO reports and professional experiences of the authors affiliated with the Canadian Cancer Society, Cancer Care Ontario, Centre for Addiction and Mental Health or the Ontario Public Health Association.

Results: A decline in tobacco use in Ontario was influenced by population level controls, community-based initiatives and smoking cessation measures; challenges remain in promoting further controls and reducing smoking. In contrast, overall consumption and high-risk alcohol use is increasing, and unhealthy eating is wide-spread in Ontario, as are physical inactivity and unhealthy weights. The multi-decade tobacco control experience in Ontario involved legislation, province-wide programs implemented by public health units and NGOs, and media campaigns. Promising initiatives focusing on alcohol, diet, physical activity and weight are currently uncoordinated, and no equivalent population-level strategies of sufficient scope and dose are evident.

Conclusion: A comprehensive approach and system-level perspective are required that include evidence-based interventions, advertising controls, community-based initiatives, regulation and economic approaches that have sufficient dose to reduce high-risk drinking, unhealthy diet, unhealthy weights and physical inactivity.